The main purpose of this proposed research is to evaluate the effectiveness of lithium carbonate against placebo in the treatment of bulimia. In pursuing our primary aim, four related subsidiary aims will be included: First, we will use standardized instruments to study the bulimic syndrome, the relation of bulimia to major depression and borderline personality disorder will be of special interest. Second, we will examine the specific effects of lithium on bulimic behavior, eating attitudes, depressive symptomatology, and social adjustment. Third, we will examine the predictors of lithium response and finally, we will study the 12-month outcome using well defined criteria and examine the prognostic indicators. The treatment of bulimia is important for several reasons: It is a serious disorder with considerable psychiatric and physical morbidity. It may lead to death through one of the major physical complications or to suicide through depression and despair. It is common and may pose a major public health hazard. Without treatment it does not seem to resolve spontaneously and patients are often relieved when offered treatment. Early reports suggested that bulimia is refractory to treatment but several preliminary studies have found that some antidepressants may be effective. However, few controlled treatment studies exist and no long term follow up has ever been conducted. In an open trial, we have treated 21 female bulimics with lithium carbonate and have followed 13 for over one year. We have found the results to be encouraging. Thus we propose an outpatient treatment study comparing lithium carbonate against placebo in 70 female bulimic patients, using an 8 week, double-blind, parallel group design. Assignment to the 2 treatment conditions will be randomized and blocked on major depression. Assessment for response will be made at 2 weekly intervals throughout the study. Furthermore, since short term response does not guarantee long term improvement, we propose to follow these patients at monthly intervals for one year. Our pilot study has demonstrated that, with careful monitoring, the use of lithium carbonate in bulimia is safe and apparently effective, and we consider that a controlled treatment and outcome study is definitely warranted.